A 6-hour nocturnal interruption of a continuous subcutaneous insulin infusion: 2. Marked attenuation of the metabolic deterioration by somatostatin

Scheen, André; Krzentowski, G.; Castillo, Manuel J.; Lefèbvre, Pierre; Luyckx, A

doi:10.1007/bf00251816

Cited by 14 publications

(14 citation statements)

References 26 publications

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“…9 vs. 4-0 ± 1.1 mU/L). This discrepancy is similar to that reported by Scheen et al , 7 and it may be more artificial than real for two reasons. I) The accuracy of free-insulin determinations may not be good enough in these low insulin concentrations.…”

Section: Resultssupporting

confidence: 83%

Overnight Interruption of Wearing Insulin Pump: Substitution Dose and Injection Site of Insulin

1986

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Discontinuing wear of the insulin pump for short periods enhances the feasibility of continuous subcutaneous insulin infusion (CSII) therapy. Because insulin requirements differ during pump and injection therapy, we studied the optimal substitution dose and injection site in seven type I diabetic patients to compensate for the overnight (2100-0730 h) interruption of CSII. The missed basal continuous infusion dose was replaced by injecting intermediate-acting insulin subcutaneously in three different ways: 1.5 times the dose in the abdomen, twice the dose in the abdomen, and twice the dose in the buttock. During CSII, glycemia remained unchanged throughout the night. Both 1.5 times and twice the replacement doses injected in the abdomen resulted in an initial decline in blood glucose with hypoglycemia in two patients followed by a rebound rise. When the replacement dose of 1.5 times was used, blood glucose rose by 4.9 +/- 1.2 mM overnight (P less than .02). These changes after abdominal injection were associated with a rapid early absorption of injected insulin with hypoinsulinemia in the morning. With twice the replacement dose injected in the buttock, insulin absorption was slower, fluctuations in nocturnal glycemia were minor, and the blood glucose level at 0730 h was similar to that of the previous night. There was a significant inverse correlation between blood glucose and serum free-insulin levels in the early morning (r = - .60, P less than .01). In conclusion, a substitution dose of 1.5 times to twice the missed basal infusion rate injected in the buttock compensates for the overnight interruption of CSII without risk of major fluctuations in blood glucose levels or nocturnal hypoglycemia.

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Section: Resultssupporting

confidence: 83%

Overnight Interruption of Wearing Insulin Pump: Substitution Dose and Injection Site of Insulin

1986

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“…The asterisks show statistically significant changes from the preceding value. (Gerich 1977;Christensen et al 1978;Dimitriadis et al 1983;Scheen et al 1983;Long et al 1979;Di Constanzo et al 1982;Weber et al 1981). …”

Section: Resultsmentioning

confidence: 94%

“…Different diseases may benefit from long-term treatment with somatostatin: peptide secreting tumours, where surgical treatment is impossible (Long et al 1979), pancreatic fistulas (Di Costanzo et al 1982), psoriasis (Weber et al 1981). There is evidence that somatostatin may be beneficial in the treatment of diabetes mellitus as an adjunct to insulin (Gerich 1977;Christensen et al 1978;Dimitriadis et al 1983;Scheen et al 1983). However, it is impracticable to use soma¬ tostatin as a chronic therapeutic agent, because this peptide has a short biological half-life (Bethge et al 1981) and has to be administered intravenously.…”

mentioning

confidence: 97%

Somatostatin plasma levels and biological effects following subcutaneous administration of somatostatin in man

Uccioli

Ghirlanda

Cotroneo

et al. 1986

Acta Endocrinologica

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The rate at which somatostatin appears in the circulation after subcutaneous bolus injection and continuous administration by pump was determined in normal subjects by serial radioimmunoassays of immunoreactive somatostatin. Following a single subcutaneous injection of 250 \g=m\g, the somatostatin peak in plasma appeared after 5 min and had only a transient effect on insulin levels. During continuous administration, somatostatin reached levels able to reduce significantly insulin and glucagon. Somatostatin plasma levels exerting biological effects were observed during the subcutaneous administration of the peptide.

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“…The size of the subcutaneous insulin depot during steady basal insulin delivery rate has been evaluated to be 2-4 times the hourly insulin infusion rate with A14-[ 125 I]monoiodoinsulin as tracer (15,16) or in kinetic modeling studies (17). This explains why blood glucose and plasma 3-hydroxybutyrate levels remain almost stable during the first 2 h of CSII interruption (2,4,5) and begin to increase later only when this subcutaneous insulin reserve has been markedly decreased, resulting in a fall in systemic insulin appearance rate (18) and low plasma free-insulin concentrations (2,4,5). In contrast to the results observed after a 1-h interruption of CSII that showed a lack of systematic metabolic alterations (6), resetting the pump at its basal rate after a 2-h CSII interruption was insufficient to quickly restore the local subcutaneous insulin depot.…”

Section: "mentioning

confidence: 99%

“…1 U/h) throughout the night. The latter data given as reference were obtained by pooling the results of the control tests from our previous studies (2,(4)(5)(6).…”

mentioning

confidence: 99%

Prevention of Metabolic Alterations by Insulin Supplements Administered Either Before or After 2-h Nocturnal Interruption of CSII

Scheen

Henrivaux²,

Jandrain

et al. 1987

Diabetes Care

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To evaluate the efficacy of a bolus insulin injection to prevent the metabolic alterations induced by a 2-h nocturnal interruption of a continuous subcutaneous insulin infusion (CSII), nine type I (insulin-dependent) C-peptide-negative diabetic patients were studied from 2200 to 0800 h during two randomized tests. An insulin bolus (2.1 +/- 0.2 U) was administered via the pump either at 2300 h, just before CSII interruption, or at 0100 h, after reactivating the pump at its usual basal rate (1.05 +/- 0.11 U/h). The insulin bolus at 2300 h induced a significant rise in plasma free-insulin levels at 2400 h (+6.9 +/- 1.8 mU/L, P less than .01), resulting in an early and marked fall in blood glucose concentrations between 2300 and 0100 h (-2.7 +/- 0.5 mM, P less than .001), with hypoglycemic values in five patients. The insulin bolus at 0100 h counteracted the fall in plasma free-insulin levels observed between 2300 and 0100 h and significantly increased plasma insulin at 0200 h (+3.2 +/- 0.8 mU/L, P less than .01). Blood glucose concentrations that remained stable during the 2-h arrest of the pump fell significantly between 0100 and 0400 h (-2.1 +/- 0.5 mM, P less than .005). This fall rate was significantly lower than that measured within the 3 h after the insulin bolus given before CSII interruption but significantly higher than that observed in a reference control group of patients whose pump was functioning normally throughout the night.(ABSTRACT TRUNCATED AT 250 WORDS)

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A 6-hour nocturnal interruption of a continuous subcutaneous insulin infusion: 2. Marked attenuation of the metabolic deterioration by somatostatin

Cited by 14 publications

References 26 publications

Overnight Interruption of Wearing Insulin Pump: Substitution Dose and Injection Site of Insulin

Overnight Interruption of Wearing Insulin Pump: Substitution Dose and Injection Site of Insulin

Somatostatin plasma levels and biological effects following subcutaneous administration of somatostatin in man

Prevention of Metabolic Alterations by Insulin Supplements Administered Either Before or After 2-h Nocturnal Interruption of CSII

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